Part 2. CHAPTER I.

PART 2

CHAPTER I

SEXUAL AND REPRODUCTIVE HEALTH OF ARMENIAN WOMEN

MATERIAL AND METHODS

Part II of the report represents results of the survey that was carried out in a national representative sample of 1400 women, ever married or in consensual union, between 15 and 44 years of age throughout Armenia. It was carried out in all 11 regions ("marzes") of the country, including the capital Yerevan. General design and methodology of the survey was described above in Introduction to this report.

2.1.1. Definitions Used and Fertility Categories

For determination of the status of a woman’s fertility we developed a diagnostic algorithm that was based on the risk of pregnancy. Any woman who had regular unprotected vaginal intercourse was considered exposed to the risk of pregnancy, if neither partner was sterilized nor had any other operative procedure that would prevent pregnancy.

For analytical purposes we used the following fertility categories: 1) fertile, 2) presumably fertile, 3) primarily infertile, 4) primarily sub-fertile, 5) secondarily infertile, and 6) secondarily sub-fertile.

Infertility was defined as inability to conceive after two years of exposure to the risk of pregnancy. If women had previously been pregnant after two or more years of exposure to the risk of pregnancy, they were classified as “Primarily infertile”. Women, whose length of exposure to the risk of pregnancy was greater than 12 months, but less than 24 months, were classified as “Primarily sub-fertile”. If the risk of exposure was less than 12 months, they were assigned to the “Unknown” category of fertility.

If women had previously been pregnant, but had been exposed to the risk of pregnancy without conceiving in the past two years, they were defined as “Secondarily infertile”. But if the risk of pregnancy was of one to two years’ duration, they were classified as “Secondarily sub-fertile”.

Pregnant women or those who had been pregnant within the preceding two years, or were breast-feeding a child were classified as “Fertile”. Those women using contraception since a pregnancy, more than two years priors were defined as “Presumably fertile”.

2.1.2. The Questionnaire Content

The questionnaire was developed by the AFHA researchers and was tested in the pilot survey of about 50 women of reproductive age. It includes two main components: 1) the household questionnaire and 2) the individual questionnaire. The household questionnaire consisted of the following sections: identification, visit records, household characteristics, and table for random selection of eligible women. The individual questionnaires covered a wide range of topics related to family health and welfare. A summary of topics and issues in the questionnaires is given below (Table 2.1.1):

Table 2.1.1. Summary of topics and issues in the questionnaire

N	TOPICS	ISSUES
Household Characteristics
1	Identification	Cluster and questionnaire numbers, address, telephone
2	Visit records and the outcome	Date and time of the visit, outcome
3	Household characteristics	Number of families, number of persons, number of eligible men, age and marital status of all eligible men
4	Table for random selection of eligible woman	Linear number of men, last digit of the questionnaire number
Individual Questionnaire
1	General information	Age of partners, citizenship, education, religious belief, frequency of the religious service attendance
2	Sexual behavior and marriage pattern	Age at first intercourse and at first marriage, number of marriages, consensual unions and sexual partners; marital status, duration of the marriage, frequency of sexual intercourse, date of the last intercourse; date and reasons of death/divorce/separation, if appropriate
3	Future intention to have children	Ideal and desired number of children, current intention to have children, reasons for not wanting more children
4	Abortion practice	Number of abortions, complications and consequences; age of women at the first and last abortion, gestational age of fetus; live births prior to abortion; main reasons, contraceptive use prior to abortion, decision making; health facility and provider, attitude of husband; psychological and physical conditions during and after abortions, post-abortion family planning, self-induced abortion practice
5	Family planning	Self-confidence about own fertility, contraceptive methods previously and currently used, failure rates, dates of starting and stopping, reasons for stopping contraception
6	Awareness, knowledge, and personal beliefs about family planning methods, STDs/AIDS	Awareness about fertile days, knowledge about contraceptive methods and where it is possible to get them, opinions about their safety, reliability, ease of use and where it is possible to get them, sources of information, attitude to abortion rights; knowledge about syphilis, gonorrhea, chlamydial infection, HIV/AIDS
7	Access to the mass media	Access to TV, radio and printed media, opinions about the best mean of public information
8	Fertility, reproductive outcome, childhood survival, breast-feeding practice	Pregnancies and outcomes in all marriages, outcome and complications of the last pregnancy, history of births, number of live births, stillbirths, and living children, congenital malformations, reasons of child’s death if any, breast-feeding practice
9	Impaired fertility	Duration of risk of pregnancy, difficulties in getting pregnant in the past and the outcome, difficulties in getting pregnant now, psychological condition of couples, family relationship, adopt
10	Access to medical services	Attendance of infertile couples for investigation and care, reasons for not attending, types of health facility, methods of investigation, diagnosis, causes, types of therapy, affordability
11	History of STDs and the symptoms, associated with the uro-genital infection	History of infection of the lower and upper genital tract, pelvo-peritonitis, cystitis, symptoms of the STDs
12	History of other diseases and disorders with possible adverse effect on fertility	Ovarian cysts and other benign tumors, uterine fibroids, cervical polyps, abdominal surgery and its complications, menstrual disorders, hirsutism, galactorrhea or other discharge from nipples
13	Harmful habits and long-term use of pharmaceutical drugs	Smoking, alcohol consumption, drug abuse, long-term use of the pharmaceutical drugs
14	Social and economic profile	Family income, employment, average monthly expenses, supports from other sources, living and housing conditions, energy and water supply, basic household amenities.

2.1.3. The Interview Status by the Regions

About 72 % of the survey sample were urban women, and 28% were rural. The requested sample of 1400 eligible respondents was identified after a total number of 1982 attempts were made to obtain informed consent to participate from the head of the household and eligible women (Table 2.1.2.). Five hundred and eighty two women (29.4%), out of those approached refused to participate in the survey. The highest refusal rate was in Tavush marz (43.4%) and the lowest in the Shirak.